EHICcups on the road to Brexit

The EU can seem quite remote from our everyday lives, and the impact of leaving, though massive, will be complex and uncertain. But there is one physical manifestation of Britain’s membership that many of us keep in our homes: the little blue EHIC card which entitles us to free or cheaper emergency treatment on holiday in European countries. People who want to retire to Europe may also be familiar with the S1 scheme, which gives pensioners the same health care rights as citizens in any country to which they choose to move across the EU, Norway, Iceland and Switzerland. When we leave the EU, can we keep our membership of these two schemes – and should we?

Worth our while?

Under these schemes the UK has to pay out for the care our citizens use in other member states, and vice versa. Looking at the numbers on where money flows, it’s easy to think the British taxpayer might be better off without them. The Nottinghamshire MP John Mann, a supporter of Brexit, demanded figures from the Department of Health which show the UK paid £674 million to EU countries, while getting only £49 million in return.

However, there are several reasons to think this overstates the benefit of leaving these arrangements. Getting rid of the S1 scheme would mean British pensioners abroad becoming liable for their own care. Faced with private bills, some might have no choice but to return to the UK, where after taking up residence they would have every right to NHS treatment. It would be understandable if the sickest, who face the highest premiums of all, would be the most likely to return.

Meanwhile, the EHIC scheme makes it that little bit easier for European businesspeople and visitors to travel to and from the UK, to the benefit of our economy. ONS figures show that well over two thirds of all tourists we receive are from Europe.

Crucially, we could probably be doing a lot better from the current system. The Department of Health estimates that as much as £305 million could be recovered from EEA visitors, mostly under EHIC. The NHS fails to do so because it is not set up to charge its patients – and because NHS trusts can receive payment much more easily by simply logging a patient as a British national. The Department hoped to raise at least £200 million by next year, and while it looks as though that target will be missed by some distance, some hospital trusts already recoup considerably more than others. Although Royal Colleges have expressed concern that their members have no time spare to act as border guards, they would probably have an even more complex task under a more ad hoc system of charging European visitors.

Pulling out of EHIC could have unexpected costs

Lastly, looking at only what the British government has to pay misses the point. Setting aside small changes in behaviour, it is likely that just as many British people as ever will find themselves in continental surgeries and A&E rooms after Brexit. Scrapping the reciprocal health care schemes won’t stop EU states from charging for that health care: it just means that they would have to do so privately. The insurance industry has made no secret of the fact that they see an opportunity: more holidaymakers will need to take out travel insurance, at higher premiums, if the EHIC scheme no longer covers care abroad. State pensioners living abroad but without full rights of residence, many on fixed incomes, could face large insurance payments or set contributions for which they had never before thought of budgeting.

Is keeping the schemes compatible with 'hard Brexit'?

Regardless of whether we want to keep these schemes alive, an important question as we move towards the publication of the government’s plans for Brexit is whether we will be able to. They form part of the EU’s Social Security Coordination programme, an immensely complex set of rules agreed between member states. A so-called “hard Brexit” which sees the UK leaving the single market is likely to leave us outside these rules.

Switzerland, a non-EU member, is also included in reciprocal social security. However, the EU has tied Swiss cooperation in a range of areas to its acceptance of the free movement of labour, something the British government opposes. Member states have made it clear that they intend to apply a similar approach to the UK. Freedom of labour seems logically connected to social security rules which are, at their heart, about creating the same rights for EU citizens regardless of the country in which they live.

In theory, there would be nothing to stop the UK developing 30 new deals with the EU states, Norway, Iceland and Switzerland to replicate the EHIC and S1 schemes after we leave. In practice, we have similar deals with only a handful of countries at present – and diplomatic attention is likely to be scarce in the historic context of Brexit.

Even for those of us who tend to lose such things quite frequently, there is a good chance that the little blue card will outlive Britain’s membership of the institution it represents.

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The Nuffield Trust is an independent health charity. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.